Risks of benzalkonium chlorides as emerging contaminants in the environment and possible control strategies from the perspective of ecopharmacovigilance

Degradation of N-methylbenzylamine and N,N-dimethylbenzylamine in anaerobic biological reactors and formation of N-nitrosomethylbenzylamine and N-nitrosodimethylamine during subsequent chloramination

As water reuse demand increases, wastewater treatment plants must manage byproducts effectively while ensuring safety. The excessive use of benzalkonium chloride disinfectants can lead to the accumulation of benzylamines, such as N-methylbenzylamine (MBA) and N,N-dimethylbenzylamine (DMBA). Biological anaerobic treatment is becoming more popular due to concerns over energy consumption and carbon emissions. Our study examined the biodegradation of MBA and DMBA during anaerobic treatment and their effects on toxic byproduct formation during subsequent chloramination, as well as their impact on bioreactor performance, degradation pathways, and microbial communities. Our results showed that anaerobic bioreactors had minimal impact on overall treatment performance despite the presence of MBA and DMBA. MBA proved resistant to biodegradation, whereas DMBA underwent significant biodegradation. Notably, during chloramination, MBA effluent formed nitroso-MBA with a 1 % molar yield, whereas DMBA effluent had significant N-nitrosodimethylamine formation, with molar yields reaching 10 ± 1 % and 97 ± 7 % of the influent and residual DMBA concentrations. We observed significant differences in microbial communities between the DMBA reactor and the MBA and control reactors. Proposed degradation pathways and the involvement of specific microbial communities were detailed. These findings highlight the importance of thoroughly evaluating biologically treated effluent to manage the risks of toxic byproducts in water reuse.

Assessing the distribution and human health risks of cationic surface-active agents in honey from China

Cationic surface-active agents (CSAAs) can persist in ambient water, be ingested by bees, and contaminate honey. Residues of CSAAs in honey remains unknown. This study measured the residual levels of five CSAAs in 271 honey samples from China using ultrahigh-performance liquid chromatography coupled with triple-quadrupole tandem mass spectrometry. Residual benzalkonium chloride-C12 (BAC-C12), BAC-C14, BAC-C16, chlorhexidine (CHG), and 4-chloraniline levels were 0.0098-2.1468, 0.0061-1.7492, 0.0012-1.6305, 0.1576-0.8401, and 0.0019-0.0234 μg kg-1, respectively. CHG and all BAC were detected in 100 % of Z. jujuba, V. negundo var. heterophylla, wildflower, L. chinensis, and D. longan Lour honey; T. tuan honey had the lowest detection rate of any CSAAs. BAC-C16 had the highest residual level among all BAC tested in Central, North China. CHG levels were detected in 91.38 % of samples in North China and 100 % in East China. BAC-C12 was significantly higher in A. cerana versus A. mellifera honey (P < 0.001). Hazard quotient and Hazard index values indicate that CSAAs residuals in honey do not pose a health risk. Correlation analysis revealed a positive correlation between BACs resides in honey and surrounding environment. The findings suggest that continuous monitoring of CSAAs in honey is imperative to ensure its safety for human consumption, while also serving as an effective matrix to assess the environmental pollution of a given region.

Environmental concentration of the quaternary ammonium disinfectant benzalkonium chloride strongly induces resistance gene profiles in fish

Disinfectants are non-antibiotic biocides that have been used extensively in daily life, particularly since the onset of the COVID-19 pandemic. However, their effect on drug resistance has not received sufficient attention. Here, marine medaka were subjected to an environmental concentration (10 μg/L) of benzalkonium chloride (BAC), sulfamethazine (SMZ), and their combination, aiming to elucidate their contributions to antibiotic resistance. Overall, 10 μg/L BAC exhibited a stronger induction potential for multiple antibiotic resistance genes (ARGs) relative to a similar level of SMZ. Specifically, tetracycline resistance genes were readily induced, regardless of exposure to BAC, SMZ, or their combination. BAC exhibited a more pronounced induction of ARGs than SMZ and showed a stronger potential to stimulate multidrug resistance. SMZ and BAC induced distinct virulence factors. Bacteria increased pathogenicity primarily through biofilm formation and enhanced community sensing under SMZ exposure, whereas iron acquisition and the production of reactive oxygen species appeared to be the main mechanisms by which bacteria evaded host defenses under BAC exposure. A greater number of ARGs demonstrated a significant positive correlation with virulence factors following BAC exposure compared to both the SMZ exposure group and the co-exposure group, which further confirmed the strong ability of BAC to induce multidrug resistance. In summary, owing to the typically unregulated and low-dose use of disinfectants in daily life and their pseudo-persistence in the environment, their potential to induce resistance may exceed that of antibiotics. Therefore, increased attention and preventive measures are required to address their resistance-inducing effects.

Common antimicrobials disrupt early zebrafish development through immune-cardiac signaling

The global production and use of antimicrobial chemicals surged during and after the COVID-19 pandemic, yet their developmental toxicity in aquatic organisms at environmentally relevant concentrations remains poorly understood. Here, we investigate and compare the developmental effects of two restricted antimicrobial chemicals-triclosan (TCS) and triclocarban (TCC)-and three alternative antimicrobials-benzalkonium chloride (BAC), benzethonium chloride (BEC), and chloroxylenol (CX)-on zebrafish embryos (Danio rerio) at concentrations of 0.4, 4, and 40 μg L-1. We find that BAC induces the most severe reduction in hatching rates, followed by TCS, TCC, BEC, and CX. BAC also exhibits the strongest inhibition of heart rate, with toxicity levels comparable to those of TCS and TCC. All tested chemicals, except CX, cause significant teratogenic effects. Transcriptomic analysis reveals substantial disruptions in immune-related coagulation cascades and mitogen-activated protein kinase signaling pathways. Further validation via protein-protein interaction network analysis and real-time quantitative polymerase chain reaction confirms that altered expression of key hub genes in these pathways impacts bone and heart development, as well as immune system function, potentially driving developmental toxicity. This study provides the first systematic comparison of developmental toxicity among currently used antimicrobials at environmentally relevant concentrations, revealing that the alternative antimicrobial BAC poses greater developmental risks than the banned TCS and TCC. These findings raise concerns about the safety of BAC as a widespread substitute and highlight the necessity for more rigorous environmental risk assessments of alternative antimicrobials before their large-scale application.

Knowledge, attitudes, and practice of medical students towards the use of benzalkonium chloride in hand sanitization from the perspective of environmental sustainability

Control measures for disinfectant pollution and related anthropogenic behaviors are required. Benzalkonium chloride (BAC) with widespread use especially in hand sanitization is highlighted as a representative disinfectant emerging contaminant. This cross-sectional survey was conducted to assess the knowledge, attitudes, practice regarding BAC use for hand hygiene among medical students from the perspective of environmental sustainability. Of the 703 responding students, only 3.7% had never used hand sanitizer products containing BAC. But few students paid attention to the "environmental friendliness" property of products when consumption. Mean knowledge test score was 1.90 out of 5, suggesting poor knowledge regarding BAC use. Most students had positive attitudes toward source control of BAC pollution and strong intentions to learn more about environmental knowledge related to BAC and other disinfectants. Data indicated that medical students had positive attitudes but lacked knowledge and practices towards eco-friendly disinfectant use, thus further training and practice standards are required.

Which emerging micropollutants deserve more attention in wastewater in the post-COVID-19 pandemic period? Based on distribution, risk, and exposure analysis

Aggravated accumulation of emerging micropollutants (EMs) in aquatic environments, especially after COVID-19, raised significant attention throughout the world for safety concerns. This article reviews the sources and occurrence of 25 anti-COVID-19 related EMs in wastewater. It should be pointed out that the concentration of anti-COVID-19 related EMs, such as antivirals, plasticizers, antimicrobials, and psychotropic drugs in wastewater increased notably after the pandemic. Furthermore, the ecotoxicity, ecological, and health risks of typical EMs before and after COVID-19 were emphatically compared and analyzed. Based on the environmental health prioritization index method, the priority control sequence of typical EMs related to anti-COVID-19 was identified. Lopinavir (LPV), venlafaxine (VLX), di(2-ethylhexyl) phthalate (DEHP), benzalkonium chloride (BAC), triclocarban (TCC), di-n-butyl phthalate (DBP), citalopram (CIT), diisobutyl phthalate (DIBP), and triclosan (TCS) were identified as the top-priority control EMs in the post-pandemic period. Besides, some insights into the toxicity and risk assessment of EMs were also provided. This review provides direction for proper understanding and controlling the EMs pollution after COVID-19, and is of significance to evaluate objectively the environmental and health impacts induced by COVID-19.

Naturally derived 3-aminoquinuclidine salts as new promising therapeutic agents

Quaternary ammonium compounds (QACs) are a biologically active group of chemicals with a wide range of different applications. Due to their strong antibacterial properties and broad spectrum of activity, they are commonly used as ingredients in antiseptics and disinfectants. In recent years, the spread of bacterial resistance to QACs, exacerbated by the spread of infectious diseases, has seriously threatened public health and endangered human lives. Recent trends in this field have suggested the development of a new generation of QACs, in parallel with the study of bacterial resistance mechanisms. In this work, we present a new series of quaternary 3-substituted quinuclidine compounds that exhibit potent activity across clinically relevant bacterial strains. Most of the derivatives had minimal inhibitory concentrations (MICs) in the low single-digit micromolar range. Notably, QApCl and QApBr were selected for further investigation due to their strong antibacterial activity and low toxicity to human cells along with their minimal potential to induce bacterial resistance. These compounds were also able to inhibit the formation of bacterial biofilms more effectively than commercial standard, eradicating the bacterial population within just 15 min of treatment. The candidates employ a membranolytic mode of action, which, in combination with the generation of reactive oxygen species (ROS), destabilizes the bacterial membrane. This treatment results in a loss of cell volume and alterations in surface morphology, ultimately leading to bacterial cell death. The prominent antibacterial potential of quaternary 3-aminoquinuclidines, as exemplified by QApCl and QApBr, paves the way for new trends in the development of novel generation of QACs.

Future Healthcare Workers and Ecopharmacovigilance: Where Do We Stand?

With the rapid development of the pharmaceutical industry and constant growth of drug usage, ecopharmacovigilance (EPV) has emerged as a way of coping with and minimizing the effects that drugs have on the environment. EPV concerns and describes unwanted effects that the use of a specific drug could have on the environment. The US, EU and Cananda are the improving position of EPV, both in legislation and practice. EPV requires further development as previous studies have shown that neither the general population nor healthcare professionals have enough knowledge about the subject. Improving awareness and knowledge about this topic is a key task for the future of EPV. The main objective was to determine students' level of knowledge about ecopharmacovigilance and to examine ways of storing and disposing of unused and expired drugs. Students' knowledge and habits were examined by a previously published survey. The survey contains twenty questions divided into three parts and the possibility of writing an additional note. There was no difference in the level of knowledge between the students of different studies. Also, students who had a family member working as healthcare professional did not show a higher level of knowledge compared to the others. Pharmacy students had a greater intention to educate their environment about EPV when compared to students of the other studies. This is in the line with a previous study which showed that the general public expects that pharmacists and physicians educate them about EPV. Medicine and dental medicine students will become prescribers after finishing their studies, and as such, they should be informed about eco-directed sustainable prescribing (EDSP) as part of an EPV strategy. More than half of the participants reported good adherence to prescribers' instruction, which decreased the amount of unused drugs. Most of the students found that the drug expiration date was legible, but they did not check it often. In comparison with similar studies, Croatian students had more knowledge and better practices concerning EPV and drug disposal. Structured learning strategies and curriculum implementation for EPV are much needed for further raising awareness about the subject among healthcare professionals and the public.

Sex-Specific Effects of Environmental Exposure to the Antimicrobial Agents Benzalkonium Chloride and Triclosan on the Gut Microbiota and Health of Zebrafish (Danio rerio)

The use of disinfectants containing benzalkonium chloride (BAC) has become increasingly widespread in response to triclosan (TCS) restrictions and the COVID-19 pandemic, leading to the increasing presence of BAC in aquatic ecosystems. However, the potential environmental health impacts of BAC on fish remain poorly explored. In this study, we show that BAC and TCS can induce the gut dysbiosis in zebrafish (Danio rerio), with substantial effects on health. Breeding pairs of adult zebrafish were exposed to environmentally relevant concentrations of BAC and TCS (0.4-40 μg/L) for 42 days. Both BAC and TCS exposure perturbed the gut microbiota, triggering the classical NF-κB signaling pathway and resulting in downstream pathological toxicity associated with inflammatory responses, histological damage, inhibited ingestion, and decreased survival. These effects were dose-dependent and sex-specific, as female zebrafish were more susceptible than male zebrafish. Furthermore, we found that BAC induced toxicity to a greater extent than the restricted TCS at environmentally relevant concentrations, which is particularly concerning. Our results suggest that environmental exposure to antimicrobial chemicals can have ecological consequences by perturbing the gut microbiota, a previously underappreciated target of such chemicals. Rigorous ecological analysis should be conducted before widely introducing replacement antimicrobial compounds into disinfecting products.

Elucidating adsorption mechanisms of benzalkonium chlorides (BACs) on polypropylene and polyethylene terephthalate microplastics (MPs): Effects of BACs alkyl chain length and MPs characteristics

Since the onset of the COVID-19 pandemic, there has been an increase in the use of disposable plastics and disinfectants. This study systematically investigated the adsorption behavior and mechanisms of benzalkonium chlorides (BACs), commonly used disinfectants, on polypropylene (PP) and polyethylene terephthalate (PET) microplastics (MPs), considering various factors, such as characteristics of MPs, alkyl chain length of BACs, and environmental conditions. Our results demonstrated a higher adsorption capacity for PP-MPs with relatively hydrophobic properties compared to PET-MPs, where longer alkyl chains in BACs (i.e., higher octanol-water partition coefficients, Kow) significantly enhanced adsorption through hydrophobic interactions. The inverse relationship between particle size of MPs and adsorption was evident. While changes in pH minimally affected adsorption on PP-MPs, adsorption on PET-MPs increased with rising pH, highlighting the influence of pH on electrostatic interactions. Moreover, MP aging with UV/H2O2 amplified BAC adsorption on PP-MPs due to surface oxidation and fragmentation, whereas the properties of PET-MPs remained unaltered, resulting in unchanged adsorption capacities. Spectroscopy studies and density functional theory (DFT) calculations confirmed hydrophobic and electrostatic interactions as the primary adsorption mechanisms. These findings improve our understanding of MPs and BACs behavior in the environment, providing insights for environmental risk assessments related to combined pollution.